Our experts answer your questions on everything from headaches to tummy aches. This month, our experts discuss whether there's anything to the alkaline water hype, how to best beat insomnia and the benefits of omega-3 fatty acids for heart health.
- Does alkaline water have therapeutic value?
- How do you put insomnia to sleep?
- Why are omega-3s good for me and how should I get them?
Alkaline water has been all the buzz in the social wellness world. The term alkaline refers to the acidity of the water, meaning it has higher amounts of basic elements such as calcium, potassium, magnesium, and bicarbonate. The theory behind it is because our body’s blood levels are slightly basic, drinking water with less acid neutralizes the acidic drinks and foods we consume. This potentially provides health benefits, such as improved digestion and metabolism, improved energy levels, and preventing chronic disease.
Some studies suggest that a diet rich in acidic foods such as meat, poultry, fish, dairy, caffeine, and sugar make the body work harder to restore a normal pH level, which means potentially pulling alkaline minerals stored in our bones. Others claim that alkaline water is the ideal rehydration solution for athletes for optimal performance due to the increase in hydrogen ions (acid) produced during exercise. These claims surrounding bone and muscle health concerns are lacking research to supports the sole use of alkaline water over tap or bottled water.
The body does a great job of maintaining an appropriate acid-base balance. Our digestive system neutralizes acidic and alkaline solutions in the stomach before it reaches the bloodstream. Also, we have organs specifically responsible for detoxification, such as the kidneys which, when working normally, are efficient at maintaining acid-base balance.
The bottom line is proper hydration is important to our health. Until further research is conducted, stick to regular water, especially if you have certain health conditions, such as kidney disease. If you’d like to go the alkaline route — for a lower cost, add baking soda to water.
How do you put insomnia to sleep?
Atul Malhotra, MD, sleep medicine specialist, UC San Diego Health
Regarding insomnia, the first step is to consider the underlying cause. Many people have trouble staying asleep or falling asleep because of other medical conditions. For example, chronic pain or restless legs syndrome can make it hard to fall asleep, breathing problems, including asthma, can wake people up from sleep, depression can lead to early morning awakening and many people with sleep apnea will also have trouble falling asleep or staying asleep, particularly amongst older folks. The first question with insomnia is to ask why.
The next step is to consider issues around sleep hygiene, which are simple behaviors that can contribute to poor quality sleep. Alcohol, tobacco and caffeine intake can all worsen sleep quality. Erratic bedtimes, excessive napping and excessive time in bed can all contribute to poor sleep quality. For people with insomnia, we generally recommend that the bed be used for intimacy and for sleep and nothing else since other activities like surfing the web, watching television, etc. can disrupt sleep as well.
If the main sleep hygiene recommendations have been addressed but insomnia persists, the next step to consider is either behavioral therapy (usually via a psychologist) or pharmacotherapy (using medications).
The Food and Drug Administration put out a black box warning on commonly used hypnotics (i.e. Lunesta, Ambien) in April 2019, but there are some patients who do well with this approach. On the other hand, if medications can be avoided the risk of side effects can be reduced. CBTI refers to cognitive behavioral therapy for insomnia and is generally provided via a psychologist who has expertise in sleep issues. Randomized trials suggest that CBTI can be quite effective for insomnia and can have sustained benefits, although some patients do well with a combination of pharmacotherapy in addition to behavioral therapy. We recommend seeing a sleep medicine specialist for evaluation of most of these patients.
Why are omega-3s good for me and how should I get them?
Michael Wilkinson, MD, cardiologist, UC San Diego Health
There are a lot of data related to the use of omega-3 fatty acids for reducing the risk of cardiovascular disease, and studies have looked at the intake of omega-3s from two different sources: from the diet (meaning from things like plants and fish) and from dietary supplements. Omega-3s are also available in prescription forms. It’s important for patients to understand the source of their omega-3 fatty acids. We know that getting omega-3 fatty acids from your diet can play a role in helping to reduce the risk of heart disease. The data are less clear on whether or not taking omega-3 fatty acids as a dietary supplement is equally effective.
When it comes to diet, there are a few ways to get more omega-3 fatty acids. One is to eat more plant-based sources of the omega-3 fatty acid called alpha-linolenic acid (ALA). ALA is found in plant oils, like flaxseed, soybean and canola oil, as well as in walnuts. The other primary omega-3 fatty acids are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are prevalent in fatty fish, like salmon, mackerel, tuna, herring and sardines. So a heart-healthy diet will include fruits, vegetables, legumes, nuts, whole grains, as well as fatty fish.
For patients who want to use a supplement, I always recommend that before taking something that they purchased over the counter, they bring in the bottle and show it to their doctor. Over-the-counter supplements can have more benefits for some patients than for others so it’s important to always have your physician weigh in.
One thing all patients can do to try and protect their hearts is to eat more fruits and vegetables. When it comes to fruits and vegetables, for most people there’s really no limit — you can and should eat as many fruits and vegetables in every form, both cooked and fresh, that you can.
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